Pediatrician Robert Dudas recalls stepping into a patient’s room and facing a parent who, quoting another doctor she saw earlier that day, was expecting her child soon to be discharged. When Dudas asked who the other doctor was, the parent hadn’t a clue.
“It happens often,” Dudas explains. “The parent will describe some physical characteristic, maybe a shorter guy with glasses, and we’ll play this game of trying to figure out who it was.”
Experiences like that, along with a study he’d read on the relative inability of hospitalized patients to identify their care givers (Arch Intern Med 2009;169(2):199-201) prompted Dudas to develop a system with colleagues at Hopkins Children’s to enhance parents’ ability to identify their child’s providers. Also, would doing that influence parents’ attitudes about trainee involvement in their child’s care and improve patient satisfaction?
“The bigger picture is parents don’t necessarily know the difference between one type of doctor and another,” Dudas explains. “What’s an intern, a resident or senior resident, a fellow or an attending? They have trouble keeping straight who all the doctors are.”
The solution for setting them straight is a visual cheat sheet of sorts called PHACES, or PHotographs of Academic Clinicians and their Educational Status, which Dudas and his colleagues piloted with 100 families of Hopkins Children’s inpatients over four months (Academic Pediatrics, March/April 2010). Half of the families received the information sheet containing passport-size photographs and brief descriptions of the medical providers’ training, and the other half did not. Both groups were asked to name their child’s providers, and then surveyed about their attitudes towards trainees.
The results? Of the PHACES parents, 82 percent were able to name at least one provider, compared to only 37 percent in the control group. PHACES parents were also more likely than the other parents to match the face with the name of the medical student – 67 percent vs. 14 percent – and attending physician – 80 percent vs. 24 percent. With a better understanding of the various physician roles, the PHACES parents were also more likely to accept the involvement of medical students and house staff in the care of their child.
“Is it okay that a medical student is touching or examining your child, or doing a procedure,” Dudas asks. “That’s not as much of an issue once you understand what it is a medical student does and that he or she is supervised. There is an attending in charge.”
In a patient satisfaction survey the PHACES parents also reported they felt more involved in decision making, and more likely to believe the medical team was being truthful. Inadvertently, Dudas added, the PHACES pilot also left some providers feeling a greater sense of responsibility to the patient and family.
“There is this idea of knowing each other that leads to improved care by the provider,” Dudas says. “If the family calls me by name, I’m going to feel more responsible for their child.”